Hedis quick reference guide updated to reflect ncqa hedis 2016 technical specifications mhs health wisconsin strives to provide quality healthcare to our membership as measured through hedis quality metrics. For example, most hedis rates reported in 2016 are based on clinical services performed in 2015. The 2016 hedis measures for qrs contained in this document are. Ffs fy 20152016 physical health performance measure. Cdc and the national committee on quality assurance have written three hedis measures related to antibiotic use in outpatient settings. Overall for hedis 2016, dsnps had higher rates on seven measures than the other snp types, compared to 19 measures for the isnps and six. Pawtjewship heaqthpqaj kf ca hedis 2016 pewfkwrajce distribution of percentile rankings by region across all measures mendocino humboldt del norte sonoma siskivou lasen solano shasta modoc trinitv marin napa lake yolo percentile northeast northwest southeast southwest 90th hpl 75th 50th 25th beqkw mpl 5 3 5 9 1 3 6 6 6 4 4 8 6 4 4 8 5 1. For hedis 2016, dhmh required healthchoice managed care organizations to report the complete hedis measure set for services rendered in calendar year 2015 to maryland medical assistance healthchoice enrollees. The tables below explain the national committee for quality assurance ncqa healthcare effectiveness data and information set hedis measures for two types of care. Originating from the national committee for quality assurance ncqa, these measures are standardized quality of care indicators used to compare health plans and providers across the nation. Hedisataglance is a reference guide designed to help your practice provide the best quality care, in alignment with the hedis standards. The survey measures in the qrs measure set will be collected as part of the qhp enrollee survey, which is largely based on items from the consumer assessment of healthcare providers and systems. The ma program performance was higher than the snp program performance for 22 of 28 measures in 2016, with significant differences for 14 of these.
National means, medians, and percentiles were calculated across all reporting health plans for 16 hedis measures included in the medicaid adult core set. Updated to reflect ncqa hedis 2016 technical specifications. Ncqa removed the utilization measures from this domain in 2015. Hedis measure member description documentation requirements codes. Clinical quality hedis 2016 summary healthcare effectiveness data and information set 1 s group health performance is above national average t group health performance is below national average. To support comparability to other measures reported for children in foster care, the age group of 6 to 17 year olds is also shown children ages 6 to 17 have better follow up than young adults ages 18 to 20 for ages 18 to 20 in medical, 7 day follow up is 56 percent, and 30 day follow up is 69 percent. Ncqa established healthcare effectiveness data and information set hedis measures specifically for snps. Measures collected using electronic clinical data systems. Annual report 2016 pdf icon pdf 261 kb annual report 2017. Ncqa, through a subcontract with rti international, generates hos samples and forwards them to survey vendors. Measures collected using electronic clinical data systems 4 ncqa collects hedis data from health plans and other healthcare organizations performance in these measures may be incorporated into payforperformance contracts of the 90 measures, 8 relate to behavioral health. Your 2016 guide to key hedis measures keywords healthcare effectiveness data and information set hedis measures help keystone first monitor care and identify opportunities to improve access to preventive and recommended services.
Your 2016 guide to key hedis measures keystone first. See table 1 for a list of the hedis measures included in 2016. Hedis is the gold standard for measuring quality health care performance, and is part of the ncqa accreditation process. Per the icd10cm official guidelines for coding and reporting fy 2016. The healthcare effectiveness data and information set hedis is one of health cares most widely used performance improvement tools. Minnesota community measurement mncm also uses some hedis measures for their data measurement. We created the hedis quick reference guide to help you increase your practices hedis rates. Previously this domain was titled utilization and relative resource use. Raceethnicity data are taken from medicaid enrollment forms, which use selfidentification to determine race and ethnicity. Hedis 2020 quick reference guide coordinated care health.
Data collected for hedis 2016 is from the calendar year 2015. Statewide executive summary hedis 2016 maryland medicaid. Visitors to this page often check hedis faqs, qrs faqs, or ask a question through myncqa. All eight healthchoice organizations reported hedis in 2016. Hedis timeliness of prenatal care postpartum care childhood immunizations wellchild visits 015 months wellchild visits 3 to 6 years adolescent well care. Care specific measures, healthy michigan plan hmp measures, and hedis measures. Use your member roster to contact patients who are due for an exam or are new to your practice take advantage of this guide, coding information, and the on. Hennepin health to submit additional hedis measures by product line. Hedis measures, which are reported on an annual basis, are divided into domains that reflect different aspects of care. Research is conducted to analyze antibiotic prescribing in order to guide policy interventions. The annual masshealth managed care hedis reports present information on the quality of care provided by the six health plans serving the masshealth managed care population.
Requirements for compliance a retinal or dilated eye exam by an eye care professional optometrist or ophthalmologist in the. Weight assessment and counseling for nutrition and physical activity for childrenadolescents. Indiana medicaid managed care quality strategy plan 2016. The audit allows comparability across organizations and ensures validity and integrity of hedis data. Hedis is a comprehensive set of standardized performance measures designed to provide purchasers and consumers with the information they need for reliable comparison of health plan performance.
Documentation must indicate the weight and bmi value for the requested calendar year. Benchmarks for medicaid adult health care quality measures. Reporting hedis rates hedis measures evaluate the previous years clinical data. Introduction 15 hedis 2016, volume 6 ncqa ncqa notifies maos that they are required to participate in the survey and provides them with guidelines for contracting with cmsapproved hos survey vendors. For clinical effectiveness of care measures of performance. The measure set includes a subset of ncqas hedis measures and one pqa measure.
Mqic provides a community result on a number of quality measures for commercial, medicaid and medicare populations, and only report measures in which recommendations are aligned in the mqic guidelines. Committed to quality care hedis quality measures hedis 2015 hedis 2016 hedis 2017 hedis 2017 medicaid quality compass 75th percentile high blood pressure and heart disease controlling high blood pressure 47. About the hedis 2016 measures reporting year 2015 hedis healthcare effectiveness data and information set is a set of performance measures developed by the national committee for quality assurance ncqa. Year 6 report hedis 2016 all plans september 2017 produced by.
Ompp uses hedis measures for tracking the percentages of members receiving followup. That makes hedis one of health cares most widely used performance improvement tools. Healthcare effectiveness data information set hedis. Ncqas accreditation process provides payers with a comprehensive. The hedis compliance audittm is required for all hedis for qrs measures in 2016, including the sampling frame used to administer the qhp enrollee survey. Ambulatory care number of outpatient and emergency department visits per member months ompp is using hedis amb to track the utilization. The term hedis originated in the late 1980s as the product of. Hennepin health, in collaboration with eight minnesota health plans, creates an annual minnesota health plan. This value set directory vsd includes value sets and codes needed to calculate and report hedis measures included in the 2016 quality rating system qrs. The following hedis measures will be included in this report. Hedis gives purchasers, physicians and consumers standardized information. Some measures, such as cervical cancer screening, look for services performed up to 5 years prior to the reporting year.
The rates are published and are publicly available. Updated to refect ncqa hedis 2020 technical specifcations. Snps report a subset of the full ma hedis measures set, so this report compares only the measures that are commonly report at the snp benefitpackage level and the ma contractlevel. Ncqa develops hedis measures through a committee represented by purchasers, consumers, health plans.